Provider Demographics
NPI:1427280734
Name:MDHOEFS DDS PC
Entity type:Organization
Organization Name:MDHOEFS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HOEFS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-477-5665
Mailing Address - Street 1:4640 CHAMPLAIN DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4714
Mailing Address - Country:US
Mailing Address - Phone:402-477-5665
Mailing Address - Fax:402-477-1478
Practice Address - Street 1:4640 CHAMPLAIN DR STE 105
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4714
Practice Address - Country:US
Practice Address - Phone:402-477-5665
Practice Address - Fax:402-477-1478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid